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JU INSIGHT Adding a Coefficient for Race to the 4Kscore Improves Calibration for Black Men
By: Helen Y. Hougen, MD, University of Iowa Hospitals and Clinics, Iowa City; Daniel D. Sjoberg, PhD, Memorial Sloan Kettering Cancer Center, New York, New York; Jamie Thomas, BA, Desai Sethi Urology Institute, University of Miami, Florida; Brandon A. Mahal, MD, University of Miami, Florida, Sylvester Comprehensive Cancer Center, University of Miami, Florida; Andrew J. Vickers, PhD, Memorial Sloan Kettering Cancer Center, New York, New York; Sanoj Punnen, MD, MAS, Desai Sethi Urology Institute, University of Miami, Florida, Sylvester Comprehensive Cancer Center, University of Miami, Florida | Posted on: 18 Mar 2024
Hougen HY, Sjoberg DD, Thomas J, Mahal BA, Vickers AJ, Punnen S. Adding a coefficient for race to the 4Kscore improves calibration for Black men. J Urol. 2024;211(3):392-399.
Study Need and Importance
Despite having a higher risk of aggressive PCa, Black men have been underrepresented in prostate cancer biomarker studies. We examined the performance of the 4Kscore test, a widely used panel of 4 serum kallikreins and clinical information, after incorporating a prespecified race coefficient that adjusts for the increased risk of high-grade prostate cancer in Black men in a Veterans Affairs (VA) cohort.
What We Found
Using data from the study that validated the 4Kscore in the US as well as a review of the literature, we prespecified a race coefficient of 0.6 on the log-odds scale (odds ratio of 1.82) for men self-identifying as Black and tested this coefficient in an independent cohort of 205 Black men from the US VA population. Including this coefficient increased the mean probability of high-grade prostate cancer in our primary cohort from 25% to 37%. It also improved the 4Kscore’s calibration (Figure) and clinical utility and maintained model discrimination.
Limitations
Race is a far from perfect correlate for biology. We know that race is a social construct incorporating complex interactions between genetic, clinical, and environmental factors and using it as a monolithic variable obscures the heterogeneity of a broadly defined racial group. However, from a population standpoint, self-reported Black race is a strong predictor of prostate cancer diagnosis; thus, until there is a better test that captures ancestry, we need to rely on self-reported race to adjust for risk. Additional limitations include inherent differences between a VA and community populations in cancer incidence and screening pattern and lack of central pathology review.
Interpretation for Patient Care
Use of the race coefficient in the 4Kscore in the preprostate biopsy setting provides a more accurate prediction of prostate cancer risk among Black men. This could improve cancer detection rates in the Black population.
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